How to Write a Successful Disability Appeal Letter

If the Social Security Administration (SSA) decides that you're not eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) disability benefits or decides to reduce the amount of your benefits, the agency will send you a notice outlining its decision. You have the right to appeal these denials of benefits.

There are four levels of appeal available to you, and you must request each appeal in turn. No matter where you are in the process, you'll need to file your appeal within 60 days of the date you received the denial notice, using the appropriate form(s) for each level of appeal. You can file your appeal online or download the form you need and mail it in or take it to your local Social Security office.

The forms include a space for you to explain why you think Social Security's decision was wrong, but you only get a few lines to write your explanation. Fortunately, you're allowed to write the phrase "see attached page" on the form and attach an appeal letter that carefully outlines the problems you see with the determination.

This article will explain how to plan and write an appeal letter for Social Security disability benefits, including samples of the kind of language to use. But before you write anything, you'll need to do a little homework.

First, Determine Why Your Claim Was Denied

Before you begin writing an appeal letter, carefully read the denial notice you received from Social Security. You'll need to fully understand why Social Security denied your disability claim (or reduced your benefits) before you can write an effective appeal letter.

Understanding the Explanation of Determination

The denial letter you receive will include an explanation of determination, which is sometimes called the "disability determination rationale" or "technical rationale." It's important to carefully read this rationale because understanding Social Security's reasons for denying your claim tells you what you need to discuss in your disability appeal letter.

The explanation of determination is supposed to be written so that it's easily understood. It shouldn't contain complicated medical or technical terms, and it should include the following information:

• a description of your medical condition
• the specific impairment(s) Social Security evaluated
• what sources were used to evaluate your claim, including:
  • medical sources (like physicians' records and emergency room visits), and
  • non-medical sources (like statements from family members and social workers), and
• the reason given for denying your claim. (For instance, if Social Security assigned you an RFC (residual functional capacity) for light work and you have some office skills, the denial notice might say your claim was denied because you can still do some kinds of work.)

Make Note of Errors and Missing Information

Start by looking for any errors Social Security might have made in evaluating your disability claim. Information that's vital to your claim could be missing or Social Security could have reported it incorrectly. Look for any of the following:

• inaccurate information about your work history
• incorrect information about your income
• missing medical records or reports
• incorrect interpretation of your functional limitations, or
• attributing job skills to you that you don't have.

Make a list of all the issues and errors you find so you can be sure that you address them in your disability appeal letter.

How to Begin Your Disability Appeal Letter

When you write a disability appeal letter to attach to your appeal form (or include with your online appeal), there's certain information you should include at the top. Start with the following headers (and corresponding information):

• Name of Claimant: [type your name], and
• Claimant Claim Number: [type your claim number (usually your Social Security number followed by a letter code)].

If your appeal letter is more than one page long, include this information at the top of each page. Doing so ensures that if your attached letter gets separated from your form, Social Security can still tell which file the letter belongs to.

After the header, start your letter by explaining briefly why you're disabled and can no longer work. Include:

• a list of your medical conditions
• a description of your symptoms (and the limitations they cause)
• when your symptoms first began (or when the injury that caused your disability occurred), and
• how your condition has changed over time

Address Any Incorrect Medical Information

Remember that list of mistakes and missing information you made when you reviewed the denial notice? For each item on the list, write a statement that points out the missing or incorrect information Social Security used to decide your claim. Make a note of the evidence you have to support your statement.

You'll need to submit the statements, records, or other information that back up your argument. Depending on your situation and what information was contained in your explanation of determination, you might need to submit:

• medical records that Social Security didn't take into account and that show your symptoms are more severe than the denial letter indicates
• new medical records (including more recent diagnostic tests) that show your symptoms have become more severe since your application (or last appeal)
• a statement from your treating doctor that goes into detail about how your doctor concluded that you're disabled and exactly what your limitations are, and
• any other documentation that supports your claim, such as your symptom or pain journal.

For example, suppose the denial letter states that your impairment isn't severe enough to prevent you from working because you can still lift 10 lbs. But you have trouble carrying a gallon of milk from the refrigerator to the table without dropping it, even after undergoing physical and occupational therapy. In this case, Social Security has an incorrect picture of your functional limitations. You'll need to explain that in your appeal letter and include any evidence or medical documentation you have to back up your claim.

Point Out Missing Medical Information

When Social Security includes the medical information and sources that were used to evaluate your claim, these sources should be listed very specifically by the doctor or hospital name. If you have an important medical source that's not specifically mentioned in your explanation of determination (like your cardiologist's report), Social Security probably didn't use it as a basis for their determination.

You should point out in your appeal letter that you have evidence and records from your doctor that Social Security didn't take into account. If you need more time to obtain some of these new tests or documents, you can let Social Security know that you intend to submit additional evidence (state the specific type of evidence) that supports your claim.

Make Sure Social Security Has the Best Evidence

If you have better sources available now than the ones Social Security used to decide your case (like more recent medical testing), you'll want to point that out in your appeal letter. And you'll want to attach this better evidence (medical records, doctor's notes, and test results) to your appeal letter.

Likewise, if Social Security based its denial on the results of a consultative exam (CE), you'll want to address that in your appeal letter too. You'll need to explain why the conclusions drawn from the CE are incorrect and share the newer and better-quality evidence you have that proves that.

For example, let's say you suffer from degenerative disc disease that causes lower back pain and COPD that makes it difficult for you to draw breaths, especially when you're physically active or emotionally distressed. You had a consultative exam that was included in Social Security's list of medical sources in the denial letter. Since the CE, you've had additional exams that show your back has gotten worse, and your COPD hasn't improved.

Make Sure Social Security Considers All Your Impairments

If you applied for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) disability based on multiple impairments, the SSA must consider the combined effect of all your impairments on your ability to work.

For instance, suppose you have rheumatoid arthritis that makes it difficult to walk and causes you a lot of pain, and you suffer from serious asthma symptoms, but neither condition is severe enough to meet a listing on its own. If Social Security evaluated your claim based only on your arthritis, and the limitations caused by your asthma weren't considered, you need to point that out and attach any evidence of the limitations your asthma causes.

Describe Any Mistakes in Social Security's Reasoning

It's possible that the Social Security examiner didn't get a clear picture of the limitations caused by your impairments. For example, the denial letter might acknowledge that you can't do everything you used to do but then state that your impairment isn't severe enough to prevent you from working because you can still lift 10 lbs.

But if your fingers don't work well enough for you to hold onto objects without dropping them, or your condition requires you to lie down several times a day, holding down a full-time job would be impossible. In a case like this, you'd use your appeal letter to describe your functional limitations in detail and explain how they keep you from working.

As always, you'll need to be ready to back up your claims with medical evidence.

Follow the Appeal Instructions and Meet the Deadlines

The decision notice you receive from Social Security denying your claim or reducing your benefits will include (along with the explanation of determination) directions on how to appeal and the deadlines you must meet. Follow all of the instructions when you file your appeal, and don't wait too long. Remember, you only have 60 days to appeal Social Security's denial.

Fill out all the required forms indicated in the decision notice. You might need to fill out more than one form, depending on what level of appeal you're at. (You can't just send in a letter appealing your claim; you must submit the proper forms with it.)

Learn more about getting your disability appeal started.

_{Updated October 31, 2022}